Health Insurance and Hospital Systems: HEAL THYSELF

Lou Beach is a brilliant artist who more recently has taken fingers to keystrokes, not to exceed more than 420 characters per story.  Here’s one from the current collection:

Zuma Pedley hailed from Lubbock, came to LA in ’02 with his guitar, some songs, and an ugly dog.  He didn’t think to change the world, wasn’t built that way, but thought music might lessen the burden of those with hearts.  He was looking for an army of smiles, but settled for a girl with corn hair and a bungalow in the hills, grew tomatoes.  The dog is still ugly.

Some things just don’t change, and one of them is our horribly broken health care system within institutional settings.  The dogs are still ugly.  Here’s the experience we’ve had over the weekend.  My wife is meticulous about details, and she had asked all the right questions prior to her stay in the hospital.  There is an incredibly obscure bean-counting in which an insurance company will not pre-certify post-surgical rehab care for total joint replacement until the surgery has been completed. In this Wizard of Oz game, the hospital case manager was to have called our carrier on Friday to obtain authorization for transfer from the hospital to the rehab center this afternoon.

As dazed as she was from the painkillers on Friday, my wife asked if everything was in place for her transition on Sunday, and she was assured that everything would be taken care of.  I heard it.  My daughter, who’s a nurse heard it.  Our questions couldn’t have been any more explicit and the answers couldn’t have been any more reassuring.

The surgery was stressful.  The hospital stay was becoming a nightmare.  For someone who hasn’t been in the hospital overnight other than to give birth, total joint replacement can be anxiety-provoking.  It wasn’t easy for her to sleep the night before, but my wife was looking forward to a get night sleep following early morning surgery.  We were in the hospital at 5:40 AM, and the surgeon had phoned at 10:30 to advise that all had gone well.  The surgery itself proved to be the only thing that went well.

This sign should have made me suspicious.  The cleanliness of a hospital’s public restroom shouldn’t be a priority.  Avoiding experiences like ours should be higher on the list.  Thursday night as my wife was trying to sleep, the elderly woman in the bed next to her was moaning in Russian.  Now don’t get me wrong.  I have nothing against Russians.  All my grandparents were from Russia.  But how many times can you listen to someone yell “Oy” repeatedly while howling in pain in any language?  Finally, they moved my wife’s roommate out to a private room.  Now you might be thinking that the reason they didn’t move my wife to a private room was because they were going to move someone into her room on Friday who would enable her to get some sleep.  Guess again.  In rolls another elderly woman, this time hearing impaired, who proceeds to call out “Hello, hello, hello, hello ….” enough times that my wife pleaded with a nurse that she couldn’t take it anymore and desperately needed some sleep.  Finally, late Friday night, a bed rolled in with a woman of matched age and quiet demeanor.  The damage had been done, but at least we could look foward to the transfer to the rehab facility on Sunday.

Sunday afternoon we had everything packed up and ready to go.  The get-well flowers, the grandchildren’s pictures, and all personal belongings were in my car.  Then the social worker came and advised us that the Reahb Facility couldn’t accept the transfer because it wasn’t authorized by the insurance company.  Huh?  How could that be?  “Well, we’re sorry, but evidently the case manager didn’t get a hold of United Health Care on Friday after all, and there’s no number at which we could reach them on the weekend.”  Illogical.  Infuriating.  But no problem — I’ll call the Rehab Facility and explain the mixup.  Even guarantee that we’ll pay for the Rehab if there’s a problem with the insurance company.  Got the Rehab Facility on the phone, only to be told “Sorry, sir.  I’m not authorized to do that.”

And so, as of this writing, 11:30 PM, my wife languishes in the hospital.  We’re hoping to get her sprung tomorrow morning, but with the way this sadly dysfunctional system works, who knows?  I’ve spoke to the surgeon’s patient coordinator.  I’ve spoken to the hospital spokesperson.  I’ve spoken to the Rehab Facility owner.  Everyone agrees with me that these things shouldn’t be happening.  But they are.  And I’ve spared you from half of the indignities and incompetence that we’ve encountered.  It’s a commentary on the system that the surgery has been a success thus far, but the post-surgical care and empathy has died.



About Leonard J. Press, O.D., FAAO, FCOVD

Developmental Optometry is my passion as well as occupation. Blogging allows me to share thoughts in a unique visual style.
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4 Responses to Health Insurance and Hospital Systems: HEAL THYSELF

  1. Roy says:

    You should have asked your Aunt Bunny to kick some butt. She however was having her own procedure on Friday morning to help with some compression fractures. Sorry to hear of the craziness. Hope Miriam is now resting more comfortably.

  2. Laya says:

    most hospitals have private rooms these days……..
    I hope things at the rehab place are better………

  3. Len Press says:

    Thanks, Roy & Laya. Miriam finally got to the Rehab facility yesterday. Pushing her hard already with PT and OT, but she is a trooper and is doing well. Thanks for all the good wishes!

  4. What an experience for Miriam !!! I hope she is doing better now and recovering well. Can you imagine how the health system will get worse yet if Obama gets his way. Helen has been having health problems, but so far no hospital stays. We need a conversation one of these days to catch up.
    Love to Miriam and the family,

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